Scenario Script

Keep confidential from participants in order not to spoil their learning experience

Scenario designer: ______________ Contact info in case of questions:

_________

This scenario has been programmed: Y/ N/ Not applicable

File name:________________________________________

Quick reference:
Patient Name: Mr. Kaushal
Hospital number: CRN 2356392
Age: 25 years
Patient Address: House number 160, Farrukh Nagar, Gurugram

Key issue (S) Clinical/ Medical Human Factors

of case:
Schizophrenia Very anxious patient

Intended Clinical/ Medical Human Factors

Learning
Objective (S) Management of  Communication
& Debriefing Schizophrenic patient among team
points: in the psychiatry ward members (Team
(using verbal de- work)
escalation techniques)  Therapeutic
communication
with the patient

Brief narrative 30 year male patient, with paranoid schizophrenia with

description for a secondary diagnosis of paranoid personality disorder.
the scenario The admission record notes a history of nonadherence,
organizers: a past suicide attempt, and a several month history of
refusal to eat, decreased sleep and social isolation. The
patient’s Global Assessment of Functioning score is 28.

Staffing/ Simulator team roles Target participants

participants 1 facilitator 1 Senior Nurse
and numbers 1 co-facilitator 1 Junior Nurse
1 relative (mother)
Case briefing For all For For scenario For scenario
participants observers participants participants
only only on standby

Instructions for all actors. Narrative description with script for patient
and actors
Patient script:
 Patient appears disheveled. He is irritable and anxious. Believes
people are conspiring against him, thus, suspicious, delusional
and paranoid. Throws furniture and threatens others who he
believes are conspiring against him.
 Previous medical history: Previously diagnosed case of Paranoid
Schizophrenia since 6 years
 Medications: Anti-psychotic drugs (for last 5 years)
 Age: 30 years
 Weight: 56 kgs
 Marital status: Unmarried
 Job & hobby: Jobless
 Smoking/ drinking habits: No
 Lifestyle: sedentary lifestyle

Relative (Mother): Look and sound anxious about the condition of Mr.
Kaushal. Emphasize that he has stopped taking his medications since
last week and hence, the deteriorating condition.

Senior Nurse: Mr. Kaushal is admitted to the psychiatry ward last night
after a suicidal attempt at home. He is increasingly agitated and begins
to throw furniture and threaten people.

Junior Nurse: Has seen the patient first and taken history from the
relative but when finds that the patient is uncontrollable, calls the senior
nurse.

Patient/ Patient on bed

manikin Hospital dress
preparation:
Props needed: None
Room and Environment simulated: Psychiatry Ward
equipment set
up Specific set-up: Psychiatric Ward with a few patients,
one or two of them requiring special attention

Equipment required:
Standardised patient
Hospital Bed and Bed Sheet
Small Table
Chair/Stool

Medical Admission document

documentation Patient file
needed
Initial
physiological Initial Parameters:
parameters
Patient: Patient agitated, throws things and threatens
and refuses treatment.

Interventions Required:
 Perform initial assessment
 Apply appropriate de-escalation techniques
Simulator Scenario Flow Chart
operation and
physiological Simulation
parameters
(scenario At 0-5 min
flowchart) Patient’s irritability and anxiousness increases
 Continue with the de-escalation techniques
 Notify co-workers

5-10 min
With the de-escalation techniques irritability and
anxiousness decrease
 Engage in appropriate communication with the
patient and involve the mother as well

Teaching information/ guidelines and references

Schizophrenia is a chronic, severe, and disabling brain disorder that has
been recognized throughout recorded history

People with schizophrenia may hear voices other people don't hear or
they may believe that others are reading their minds, controlling their
thoughts, or plotting to harm them. These experiences are terrifying
and can cause fearfulness, withdrawal, or extreme agitation. People
with schizophrenia may not make sense when they talk, may sit for
hours without moving or talking much, or may seem perfectly fine until
they talk about what they are really thinking. Because many people
with schizophrenia have difficulty holding a job or caring for themselves,
the burden on their families and society is significant as well.

Available treatments can relieve many of the disorder's symptoms, but

most people who have schizophrenia must cope with some residual
symptoms as long as they live. Nevertheless, this is a time of hope for
people with schizophrenia and their families
Notes

Scenario observation sheet

Date: Start time: End time:
Patient name:
Faculty name:
Candidate:
Observed key events and main debriefing points
Clinical/
medical
related

Human factors
related

Notes: